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Stroke. 2019 Apr;50(4):783-788. doi: 10.1161/STROKEAHA.118.024143.

Atrial Fibrillation and Brain Magnetic Resonance Imaging Abnormalities.

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From the Cardiovascular Division, Department of Medicine, University of Minnesota Medical Center, Minneapolis (J.P.B., L.Y.C.).
Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (F.L.N., P.L.L.).
Department of Neurology, University of Mississippi Medical Center, Jackson (T.M.).
Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.).
Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.).
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.).


Background and Purpose- Atrial fibrillation (AF) is associated with dementia independent of clinical stroke. The mechanisms underlying this association remain unclear. In a community-based cohort, the ARIC study (Atherosclerosis Risk in Communities), we evaluated (1) the longitudinal association of incident AF and (2) the cross-sectional association of prevalent AF with brain magnetic resonance imaging (MRI) abnormalities. Methods- The longitudinal analysis included 963 participants (mean age, 73±4.4 years; 62% women; 51% black) without prevalent stroke or AF who underwent a brain MRI in 1993 to 1995 and a second MRI in 2004 to 2006 (mean, 10.6±0.8 years). Outcomes included subclinical cerebral infarctions, sulcal size, ventricular size, and, for the cross-sectional analysis, white matter hyperintensity volume and total brain volume. Results- In the longitudinal analysis, 29 (3.0%) participants developed AF after the first brain MRI. Those who developed AF had higher odds of increase in subclinical cerebral infarctions (odds ratio [OR], 3.08; 95% CI, 1.39-6.83), worsening sulcal grade (OR, 3.56; 95% CI, 1.04-12.2), and worsening ventricular grade (OR, 9.34; 95% CI, 1.24-70.2). In cross-sectional analysis, of 969 participants, 35 (3.6%) had prevalent AF at the time of the 2004 to 2006 MRI scan. Those with AF had greater odds of higher sulcal (OR, 3.9; 95% CI, 1.7-9.1) and ventricular grade (OR, 2.4; 95% CI, 1.0-5.7) after multivariable adjustment and no difference in white matter hyperintensity or total brain volume. Conclusions- AF is independently associated with increase in subclinical cerebral infarction and worsening sulcal and ventricular grade-morphological changes associated with aging and dementia. More research is needed to define the mechanisms underlying AF-related neurodegeneration.


atrial fibrillation; cognitive dysfunction; dementia; magnetic resonance imaging; research

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